Successful Steroid Therapy in a Child with Suspected Autoimmune Hepatitis

Abstract

Introduction: Autoimmune Hepatitis (AIH) is an unexplained cause of chronic and progressive liver inflammation. The incidence of AIH is about 4.82/per 100,000 people in Korea, but based on global research the incidence is increasing and it should be taken more seriously. Laboratory and imaging tests were performed which led to the diagnosis of AIH but to diagnose AIH is difficult. Steroid therapy is an option for this patient by considering the side effects that are well-monitored. A favourable outcome was shown and this report is expected to highlight the importance of early diagnosis and treatment in AIH cases. Case presentation: A 6-year-old, 5-month-old girl presented to Dr. Soetomo General Academic Hospital, Surabaya with jaundice for 2 weeks. She had been unable to walk for the past 1 month due to pain in both legs, nausea and vomiting, anorexia, right-sided abdominal pain, and an enlarged abdomen. She has had a history of fever for the past 1 month. Laboratory parameters showed cholestasis, abnormal liver function test (aspartate aminotransferase (AST) 1406 U/L, alanine aminotransferase (ALT) 1392 U/L, and prolonged coagulation factor), and positive antinuclear antibody (ANA) test (79.10 AU/mL). Hepatitis markers were negative. Liver biopsy and autoantibodies examination (LKM and SMA) was not done due to limited facilities. Hepatitis, cholecystitis, and ascites were noted on abdominal ultrasonography. Ascites and cholecystitis were seen on an abdominal CT scan. Steroid therapy was administered and there was improvement in clinical condition and laboratory results following two weeks duration of treatment. Conclusion: This case report illustrates that steroid treatment for a child with AIH results in a good improvement and provides achievement of treatment goals following existing guidelines. The use of steroid therapy in suspected cases of AIH, without further diagnostic modalities, may be of value in the prevention of further liver damage, especially in healthcare settings with limited resources.